Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT DURAL IMPLANT 1X1 DURAFO

Facility

$4,840.00

Hospital Charge Code	270663921
Hospital Revenue Code	278
Min. Negotiated Rate	$726.00
Max. Negotiated Rate	$1,171.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,064.80
Rate for Payer: Qualcare PPO/HMO/WC	$726.00

GRAFT ENDO EXC 12x16 PXT261216

Facility

$38,895.00

Hospital Charge Code	270639870V
Hospital Revenue Code	278
Min. Negotiated Rate	$5,834.25
Max. Negotiated Rate	$9,412.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,779.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,412.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,556.90
Rate for Payer: Qualcare PPO/HMO/WC	$5,834.25

GRAFT ENDO EXC 12x16 PXT261216

Facility

$38,895.00

Hospital Charge Code	270639870V
Hospital Revenue Code	278
Min. Negotiated Rate	$937.37
Max. Negotiated Rate	$19,447.50
Rate for Payer: Aetna Commercial	$14,780.10
Rate for Payer: Aetna Medicare Advantage	$11,668.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,918.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,918.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,779.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,918.23
Rate for Payer: Cigna Commercial	$19,447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,412.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,556.90
Rate for Payer: Qualcare PPO/HMO/WC	$5,834.25
Rate for Payer: UnitedHealthcare Community & State	$937.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1,030.72

GRAFT EPIFIX 2.0x3.0CM

Facility

$5,720.00

Service Code	HCPCS Q4186
Hospital Charge Code	270658379
Hospital Revenue Code	278
Min. Negotiated Rate	$858.00
Max. Negotiated Rate	$1,384.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,384.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,258.40
Rate for Payer: Qualcare PPO/HMO/WC	$858.00

GRAFT EPIFIX 2.0x3.0CM

Facility

$5,720.00

Service Code	HCPCS Q4186
Hospital Charge Code	270658379
Hospital Revenue Code	278
Min. Negotiated Rate	$137.85
Max. Negotiated Rate	$1,384.24
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,384.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,258.40
Rate for Payer: Qualcare PPO/HMO/WC	$858.00
Rate for Payer: UnitedHealthcare Community & State	$137.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$151.58

GRAFT EPIFIX 2.0x3.0CM/SQCM JW

Facility

$1,104.17

Hospital Charge Code	270658379W
Hospital Revenue Code	636
Min. Negotiated Rate	$26.61
Max. Negotiated Rate	$552.09
Rate for Payer: Aetna Commercial	$419.58
Rate for Payer: Aetna Medicare Advantage	$331.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.56
Rate for Payer: Cigna Commercial	$552.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.21
Rate for Payer: Qualcare PPO/HMO/WC	$165.63
Rate for Payer: UnitedHealthcare Community & State	$26.61
Rate for Payer: Wellpoint Medicaid Managed Care	$29.26

GRAFT EPIFIX 2.0x3.0CM/SQCM JW

Facility

$1,104.17

Hospital Charge Code	270658379W
Hospital Revenue Code	636
Min. Negotiated Rate	$165.63
Max. Negotiated Rate	$267.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.21
Rate for Payer: Qualcare PPO/HMO/WC	$165.63

GRAFT EPIFIX 4.0x4.5CM

Facility

$6,970.00

Service Code	HCPCS Q4186
Hospital Charge Code	270680653
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,686.74
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,394.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,686.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,533.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,045.50
Rate for Payer: UnitedHealthcare Community & State	$167.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$184.71

GRAFT EPIFIX 4.0x4.5CM

Facility

$6,970.00

Service Code	HCPCS Q4186
Hospital Charge Code	270680653
Hospital Revenue Code	278
Min. Negotiated Rate	$1,045.50
Max. Negotiated Rate	$1,686.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,394.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,686.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,533.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,045.50

GRAFT EXCLUDER AAA ENDOPRO CL

Facility

$23,695.00

Hospital Charge Code	270683789
Hospital Revenue Code	278
Min. Negotiated Rate	$3,554.25
Max. Negotiated Rate	$5,734.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,739.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,734.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,212.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,554.25

GRAFT EXCLUDER AAA ENDOPRO CL

Facility

$23,695.00

Hospital Charge Code	270683789
Hospital Revenue Code	278
Min. Negotiated Rate	$571.05
Max. Negotiated Rate	$11,847.50
Rate for Payer: Aetna Commercial	$9,004.10
Rate for Payer: Aetna Medicare Advantage	$7,108.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,042.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,042.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,739.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,042.23
Rate for Payer: Cigna Commercial	$11,847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,734.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,212.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,554.25
Rate for Payer: UnitedHealthcare Community & State	$571.05
Rate for Payer: Wellpoint Medicaid Managed Care	$627.92

GRAFT EXCLUDER AAA ENDOPRO MB

Facility

$57,785.00

Hospital Charge Code	270683788
Hospital Revenue Code	278
Min. Negotiated Rate	$1,392.62
Max. Negotiated Rate	$28,892.50
Rate for Payer: Aetna Commercial	$21,958.30
Rate for Payer: Aetna Medicare Advantage	$17,335.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,735.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,735.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,557.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,735.17
Rate for Payer: Cigna Commercial	$28,892.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,983.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,712.70
Rate for Payer: Qualcare PPO/HMO/WC	$8,667.75
Rate for Payer: UnitedHealthcare Community & State	$1,392.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1,531.30

GRAFT EXCLUDER AAA ENDOPRO MB

Facility

$57,785.00

Hospital Charge Code	270683788
Hospital Revenue Code	278
Min. Negotiated Rate	$8,667.75
Max. Negotiated Rate	$13,983.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,557.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,983.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,712.70
Rate for Payer: Qualcare PPO/HMO/WC	$8,667.75

GRAFT EXTENDER ILIAC PXL161007

Facility

$11,427.90

Hospital Charge Code	270635534
Hospital Revenue Code	278
Min. Negotiated Rate	$1,714.18
Max. Negotiated Rate	$2,765.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,285.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,765.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,514.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,714.18

GRAFT EXTENDER ILIAC PXL161007

Facility

$11,427.90

Hospital Charge Code	270635534
Hospital Revenue Code	278
Min. Negotiated Rate	$275.41
Max. Negotiated Rate	$5,713.95
Rate for Payer: Aetna Commercial	$4,342.60
Rate for Payer: Aetna Medicare Advantage	$3,428.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,914.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,914.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,285.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,914.11
Rate for Payer: Cigna Commercial	$5,713.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,765.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,514.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,714.18
Rate for Payer: UnitedHealthcare Community & State	$275.41
Rate for Payer: Wellpoint Medicaid Managed Care	$302.84

GRAFT EXTENDER ILIAC PXL161007

Facility

$13,550.00

Hospital Charge Code	270635534V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,032.50
Max. Negotiated Rate	$3,279.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,279.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,981.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,032.50

GRAFT EXTENDER ILIAC PXL161007

Facility

$13,550.00

Hospital Charge Code	270635534V
Hospital Revenue Code	278
Min. Negotiated Rate	$326.56
Max. Negotiated Rate	$6,775.00
Rate for Payer: Aetna Commercial	$5,149.00
Rate for Payer: Aetna Medicare Advantage	$4,065.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,455.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,455.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,455.25
Rate for Payer: Cigna Commercial	$6,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,279.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,981.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,032.50
Rate for Payer: UnitedHealthcare Community & State	$326.56
Rate for Payer: Wellpoint Medicaid Managed Care	$359.07

GRAFT EXTREMITY 4CC INJECTABLE

Facility

$10,350.00

Hospital Charge Code	270656821
Hospital Revenue Code	278
Min. Negotiated Rate	$1,552.50
Max. Negotiated Rate	$2,504.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,504.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,277.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,552.50

GRAFT EXTREMITY 4CC INJECTABLE

Facility

$10,350.00

Hospital Charge Code	270656821
Hospital Revenue Code	278
Min. Negotiated Rate	$249.44
Max. Negotiated Rate	$5,175.00
Rate for Payer: Aetna Commercial	$3,933.00
Rate for Payer: Aetna Medicare Advantage	$3,105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,639.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,639.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,639.25
Rate for Payer: Cigna Commercial	$5,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,504.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,277.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,552.50
Rate for Payer: UnitedHealthcare Community & State	$249.44
Rate for Payer: Wellpoint Medicaid Managed Care	$274.27

GRAFT FEP RING 10MM X 80CM

Facility

$7,100.00

Hospital Charge Code	270637443
Hospital Revenue Code	278
Min. Negotiated Rate	$171.11
Max. Negotiated Rate	$3,550.00
Rate for Payer: Aetna Commercial	$2,698.00
Rate for Payer: Aetna Medicare Advantage	$2,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,810.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,810.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,810.50
Rate for Payer: Cigna Commercial	$3,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,718.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,562.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,065.00
Rate for Payer: UnitedHealthcare Community & State	$171.11
Rate for Payer: Wellpoint Medicaid Managed Care	$188.15

GRAFT FEP RING 10MM X 80CM

Facility

$7,100.00

Hospital Charge Code	270637443
Hospital Revenue Code	278
Min. Negotiated Rate	$1,065.00
Max. Negotiated Rate	$1,718.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,718.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,562.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,065.00

GRAFT FEP RINGED THIN WALLED

Facility

$6,355.00

Service Code	HCPCS C1768
Hospital Charge Code	270601127
Hospital Revenue Code	278
Min. Negotiated Rate	$953.25
Max. Negotiated Rate	$1,537.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,271.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,537.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,398.10
Rate for Payer: Qualcare PPO/HMO/WC	$953.25

GRAFT FEP RINGED THIN WALLED

Facility

$6,355.00

Service Code	HCPCS C1768
Hospital Charge Code	270601127
Hospital Revenue Code	278
Min. Negotiated Rate	$153.16
Max. Negotiated Rate	$3,177.50
Rate for Payer: Aetna Commercial	$2,414.90
Rate for Payer: Aetna Medicare Advantage	$1,906.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,620.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,620.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,271.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,620.53
Rate for Payer: Cigna Commercial	$3,177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,537.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,398.10
Rate for Payer: Qualcare PPO/HMO/WC	$953.25
Rate for Payer: UnitedHealthcare Community & State	$153.16
Rate for Payer: Wellpoint Medicaid Managed Care	$168.41

GRAFT FEP RING TW 060300802***

Facility

$5,198.00

Hospital Charge Code	1604057
Hospital Revenue Code	278
Min. Negotiated Rate	$125.27
Max. Negotiated Rate	$2,599.00
Rate for Payer: Aetna Commercial	$1,975.24
Rate for Payer: Aetna Medicare Advantage	$1,559.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,325.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,325.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,325.49
Rate for Payer: Cigna Commercial	$2,599.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,257.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,143.56
Rate for Payer: Qualcare PPO/HMO/WC	$779.70
Rate for Payer: UnitedHealthcare Community & State	$125.27
Rate for Payer: Wellpoint Medicaid Managed Care	$137.75

GRAFT FEP RING TW 060300802***

Facility

$5,198.00

Hospital Charge Code	1604057
Hospital Revenue Code	278
Min. Negotiated Rate	$779.70
Max. Negotiated Rate	$1,257.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,257.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,143.56
Rate for Payer: Qualcare PPO/HMO/WC	$779.70

Know your out-of-pocket cost for care.

All Charges